Long-term Clinical Outcomes After Atrial Fibrillationablation In Patients With Impaired Left Ventricular Function:Compared With Pharmacological Rate Control

Purpose:Atrial fibrillation(AF)has a high morbidity as well as heart failure(HF),patients with heart failure commonly develop atrial fibrillation(AF),AF adversely affects the prognosis in patients with HF.They share common risk factors and frequently coexist and associated with higher morbidity and mortality.There is some controversy over rhythm or rate control about the management of the AF patients.Catheter ablation(CA)in atrial fibrillation patients with reduced left ventricular ejection fraction(LVEF)is increasingly,but long-term outcomes are sparse.We compared the outcomes in patients with AF and reduced LVEF between AF ablation and Pharmacological Rate control,and compared the success rate of AF ablation between patients with AF and low EF and patients with AF and normal LVEF.Method: 120 patients with congestive heart failure and a left ventricular ejection fraction of less than 45 percent who were referred for circumferential pulmonary vein isolation(CPVI)with or without additional substrate modification in our hospital during 2006–2012(group A).We selected 150 patients without congestive heart failure who were undergoing ablation for atrial fibrillation(group B)and the other150 paitients with atrial fibrillation and heart failure(AF-HF)treated with anti-arrhythmic drugs(AADS)as control groups,matched according to age,sex,and classification of atrial fibrillation.24-hour ambulatory electrocardiography was performed prior and post catheter ablation of AF(i.e.,1-2 days)to monitor Heart rate and rhythm.Patients were confirmed no contraindications by routine laboratory tests,ECG,X-ray,TEE and CT scanning of pulmonary vein before ablation.All patients underwent the CPVI procedure guided by the 3D mapping system.We compared the success rate between the AF-HF patients and AF patients without HF,and compared the LVEF,NYHA class,hospital admission rate,the incidence of stroke,mortality between the AF ablation and pharmacological rate control.Success was defined free of any episode of atrial tachyarrhythmias lasting >30s recorded by surface ECG or Holter after the blanking period(3 months after the procedure).Results:1.The comparision of each groups and subgroups about age,gender,course of Af,history of high blood pressure and echocardiography results(LAD,LVDD,LVEF)are withoutthe statistic significance(P > 0.05).2.The duration of fluoroscopy,duration of procedure,complications et al between group A and group B had no statistically differences.79/120(65.8%)patients remained in SR in the group A at the first 12 month,while 107/150(71%)patients remained in SR in the group B(P=0.20);67/120(55.8%)patients remained in SR in the group A,while 98/150(65.3%)patients remained in SR in the group B(P=0.07)at the second 12 month;55/120(45.8%)patients remained in SR in the group A,while 92/150(61.3%)patients remained in SR in the group B(P<0.01)at the end of FU.3.During the FU,the hospital admission rate between the group A and group C had a statistically differences(1.8±1.4 vs 3.1±1.0,P<0.01).The incidence of stroke between the two groups also had a statistically differences(11/120,9.2% VS 32/150,21.3%)(P=0.007).,as well as the mortality between the two groups(9/120,7.5% VS 27/150,18%)(P=0.012).4.The NYHA class between the prior and post procedure in group A had a statistically differences(2.7±0.6 VS 1..3±0.5 P<0.0),as well as the parame ter of TTE(LVEF 41.9% VS 53.8% P<0.01,LAD 39.2mm ±4.5 VS 41.9mm±4.2 P=0.23,LVEDD 58.2±4.3mm VS 55.1±6.2mm P=0.12)5.The success rate of CA in patients with suspected tachycardia-induced cardiomyopathy(s/TM)was higher than patients with dilated cardiomyopathy(DCM)or patients with structural heart disease(SHD)(58.2% VS 40.0% VS10.3%,P<0.01).Death occurred significantly more often in DCM group than s TM group,but SHD group and DCM group had no statistically difference(DCM VS s TM:5/28 VS1/57,p=0.014;SHD VS s TM:3/34 VS 1/57,p=0.14,SHD VS DCM:3/34 VS 5/28,p=0.45).Conclusion:1.A catheter ablation strategy in patients with Impaired Left Ventricular Function can reduce the hospitalizations for heart failure and mortality,prevent for stroke and Improvement of systolic LV function in a comparison with medical treatment.2.The success rate of ablation in AF patients was higher than AF patient with HF with elongation of the follow up.3.AF Patients with heart failure without structural heart disease,with poor hart rate control prior the procedure,had the better outcome after the procedure.